This study seeks to investigate the distribution of the angiotensin-converting enzyme (ACE) gene polymorphism and serum levels in patients with viral pneumonia and predict which polymorphism will lead to severe progression of the disease. The serum ACE levels and ACE gene polymorphisms were successfully evaluated with respect to subsequent viral pneumonia using records of 100 patients with viral pneumonia and 100 healthy controls. ACE serum concentration was statistically significantly elevated. ACE serum concentration with a cut-off value of ≥5,256.05 pg/mL had 85.3% sensitivity and 83.2% selectivity. In addition, patients with ACE genotype D/D were 0.08 times more likely to manifest severe lung involvement than those with I/I, and patients with the I/D genotype were 0.02 times more likely than their counterparts with I/I. The computed tomography findings of the patients revealed that ACE serum concentration was significantly effective in discriminating between mild and moderate-to-severe lung involvement. No significant difference was observed between the blood parameters and ACE genotype distributions. I/D polymorphism likely affects the expression of the ACE gene and/or the function of the angiotensin I converting enzyme. The D/D genotype is associated with vessel wall thickness and higher blood pressure. Strong evidence was found between D/D and I/D genotypes in the patient cohort concerning genotypes and ACE serum concentration. Further analysis showed that ACE serum levels were more elevated in the D/D genotype compared to the I/D genotype in the patient cohort.

Objective: To determine the cost analysis of emergency department (ED) visits by geriatric patients living in nursing homes. Study Design: Cross-sectional study. Methodology: Medical records of geriatric patients living in nursing homes who were admitted to the emergency department of the Hospital, between 2011 and 2015, were retrospectively reviewed. Number of visits, reason, and cost of treatment was determined. Results: In total 63 patients (21 females [33.3%], 42 males [66.6%]) with mean age of 76.3 +/- 8.16 years were included. The total number of emergency department visits by those 63 patients was 243. Twenty-three (9.5%) of the total emergency department visits were due to trauma. Six patients (9.5%) were admitted to the emergency department with cardiopulmonary arrest. The mean cost of each patient was $358.30 (53.90 - 1734.10), the maximum cost was $10,095.10, and the minimum cost was $7.42. Conclusion: Emergency department visits and hospitalisation are common among elderly patients living in nursing homes. However, emergency department visits by this frail population put a heavy burden on the economy. Essential measures should be taken to reduce the financial burden of emergency department visits and hospitalisation of this geriatric population.

OBJECTIVE: Tonsillopharyngitis is one of the constituents of upper respiratory tract infection (URTI). Fever is a URTI symptom requiring treatment due to the occurrence of discomfort and high fever-based complications. This study primarily sets out to observe and compare the efficacy of intravenous administration of paracetamol and ibuprofen drugs on fever in adult patients with tonsillopharyngitis. METHODS: This study was performed in a prospective, randomized controlled, double-blind design. The study population was divided as Group 1 (treated with paracetamol) and as Group 2 (treated with ibuprofen). While the first group was treated with paracetamol as 1000 mg in 150 ml normal saline, the second group was treated with ibuprofen as 400 mg in 150 ml normal saline. The primary outcome was the decrease in fever at 15, 30, and 60 min, while the secondary outcome was the need for additional treatment after 60 min. RESULTS: One hundred and eighty-five patients were included in the final analysis. The mean age of the paracetamol group (57.4% male) was 28.36 ± 9.6, whereas that of the ibuprofen group (54.9% male) was 27.45 ± 7.98. Fever was reduced significantly between 0 and 60 min in both groups (P ≤ 0.001 and P ≤ 0.001, respectively). Although the antipyretic effect of ibuprofen was more pronounced in the early period than that of paracetamol, no significant difference was noted between the two groups in terms of fever drop between 0 and 60 min (P = 0.350). CONCLUSION: Although both drugs prove effective in controlling fever at the 60 min, stronger efficacy of ibuprofen in the first 15 min may enable rapid discharge from the emergency department.

Aims. In this study, we aim to unravel the relationship between coagulation parameters together with D‐dimer and the severity of coronavirus disease (COVID‐19) during hospitalization as well as hospitalization in the intensive care unit (ICU). Methods. This retrospective study was conducted in the Emergency Department (ED) of Pamukkale University Hospital (Denizli, Turkey) between March 1 and April 30, 2020. SARS‐CoV‐2 polymerase chain reaction (PCR) tests and laboratory tests, including international normalized ratio (INR), prothrombin time (PT), D‐dimer, and activated thromboplastin time (APTT), were requested from 289 people presenting to the ED with symptoms of upper respiratory tract infection (URTI), such as cough, fever, and sore throat. Results. While 110 patients turned out to be polymerase chain reaction (PCR) positive, 181 individuals were PCR negative. The mean D‐dimer level of the patient group was 147 ng/ml DDU (min: 9, max: 2948), and their mean PT level was found as 12.8 seconds (min: 10.3, max: 34.7). Besides, the mean APTT was 31.25 seconds (min: 19, max: 46.9), and the mean INR level was calculated as 1.09 (min: 0.88, max: 2.93). 35 of the patients were not hospitalized, while 43 were admitted to the Infectious Diseases, 20 to the Chest Diseases, and 12 to the ICU. Conclusions. It can be concluded from our findings that D‐dimer, PT, and INR levels remained elevated in the COVID‐19‐diagnosed patients, but these parameters were unable to discriminate accurately between the patients with positive and negative SARS‐CoV‐2 results. Our findings also suggest that coagulation parameters might occupy a critical role in documenting clinical severity in patients with COVID‐19 infection and requiring hospitalization.